title: Silver negative pressure dressing with vacuum-assisted closure of massive pelvic and extremity wounds.
abstract: BACKGROUND
  Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested.
  
  
  OBJECTIVE
  Does a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition?
  
  
  METHODS
  We evaluated 42 patients with massive (> 200 cm(2)) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing.
  
  
  RESULTS
  Hospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033).
  
  
  CONCLUSIONS
  Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopaedic Oncology, Department of Surgery, UAB School of Medicine, Birmingham, AL, 35305, USA, hsiegel@uabmc.edu.
authors.forename: Herrick J
authors.initials: HJ
authors.lastname: Siegel
authors.forename: Diego F
authors.initials: DF
authors.lastname: Herrera
authors.forename: Jason
authors.initials: J
authors.lastname: Gay
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003646:Debridement; D004867:Equipment Design; D005121:Extremities / Q000293:injuries*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation*; D010388:Pelvis / Q000293:injuries*; D012834:Silver / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; C500574:silverlon; D012834:Silver